Two hundred forty-three stents (203 Palmaz-Schatz, 40 Glanturco-Roubin) were electively Implanted in 188 lesions in 168 patients (mean age 58 +/- 10 years, 77% males) using angiographic but not ultrasound guidance. Patients were treated subsequently with aspirin and observed in hospital for up to 7 days. Those with acute myocardial infarction, radiolucent defects in coronary arteries suggestive of thrombus, and results that were not optimal after stent implantation were anticoagulated with warfarin and not Included in the study. Two had subacute stent thrombosis and two patients non-Q-wave myocardial infarction in-hospital. At follow-up (median 149 days) none had had subacute stent thrombosis, one suffered non-Q-wave myocardial infarction, none had died, and none had developed major complications at the vascular access site. Fourteen (8%) had undergone further revascularisation procedures. This initial experience suggests that aspirin is sufficient to prevent subacute stent thrombosis after elective high pressure assisted coronary stent implantation without intravascular ultrasound guidance if the angiographic appearance after stent deployment is optimal.

The ODYSSEY OUTCOMES trial, comprising over 47 000 patient-years of placebo-controlled observation, demonstrated important reductions in the risk of recurrent ischaemic cardiovascular events with the monoclonal antibody to proprotein convertase subtilisin/kexin type 9 alirocumab, as well as lower all-cause death. These benefits were observed in the context of substantial and persistent lowering of low-density lipoprotein cholesterol with alirocumab compared with that achieved with placebo. The safety profile of alirocumab was indistinguishable from matching placebo except for a ∼1.7% absolute increase in local injection site reactions. Further, the safety of alirocumab compared with placebo was evident in vulnerable groups identified before randomization, such as the elderly and those with diabetes mellitus, previous ischaemic stroke, or chronic kidney disease. The frequency of adverse events and laboratory-based abnormalities was generally similar to that in placebo-treated patients. Thus, alirocumab appears to be a safe and effective lipid-modifying treatment over a duration of at least 5 years.